2014-08-15T13:03:30-05:00 2013-09-30 411765929 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2012-10-01 411263433 KNUTE NELSON KNUT 3207636653 420 12TH AVENUE EAST ALEXANDRIA MN 56308 MARK ANDERSON 3207636653 2014-08-14 1 SARAH VOGT CPA P00978242 6122536500 2014-08-13 2012 2015-11-30 17:44:51Z MARK ANDERSON 420 12TH AVENUE EAST ALEXANDRIA MN 56308 21510106 0 9386 X WWW.KNUTENELSON.ORG X 1969 MN OPERATION OF NURSING HOME AND SENIOR SERVICES 9 9 572 340 118154 -121685 5284 138619 18071000 21283161 90821 88326 0 0 18167105 21510106 17074 17054 0 0 12069842 13595604 0 0 1539 7978994 8581181 20065910 22193839 -1898805 -683733 43291924 42828720 29658787 29702578 13633137 13126142 X THE MISSION OF KNUTE NELSON IS TO ENRICH THE LIVES OF EVERYONE WE SERVE. OUR VISION IS TO BE THE RECOGNIZED LEADER OF QUALITY AND INNOVATIVE SERVICES FOR ALL STAGES OF LIVING. 1 0 19982647 17054 21283161 KNUTE NELSON, AN AFFILIATE OF EVANGELICAL LUTHERAN CHURCH OF AMERICA, PROVIDES A FULL CONTINUUM OF SERVICES FOR OLDER ADULTS TO ENHANCE THEIR QUALITY OF LIFE THROUGH A 108-BED SKILLED NURSING FACILITY, 73 INDEPENDENT LIVING APARTMENTS, 123 ASSISTED LIVING UNITS, A HOME CARE AGENCY, AND A HOSPICE AGENCY.KNUTE NELSON HAS 480+ EMPLOYEES AND 340 VOLUNTEERS MAKING IT ONE OF THE TOP FIVE EMPLOYERS IN ALEXANDRIA. WITHIN THE SKILLED NURSING FACILITY, WE HAVE A SHORT-TERM REHAB UNIT, REHABILITATION PROGRAM, CARE SUITES FOR END-OF-LIFE PROGRAMMING AND PROVIDE HOSPICE CARE IN PARTNERSHIP WITH LOCAL HOSPICE PROVIDERS FOR TERMINALLY-ILL RESIDENTS. WE ALSO HAVE A WELLNESS PROGRAM THAT PROVIDES CLASSES FOR RESIDENTS, ACTIVITIES, AND A CHAPLAINCY PROGRAM; ALL WHICH ENHANCE THEIR QUALITY OF LIVING. OUR CHAPLAINCY PROGRAM IS GUIDED BY CHRISTIAN PRINCIPLES. ALL FAITHS ARE CELEBRATED HERE AND OUR CHAPLAIN PROVIDES A WIDE RANGE OF SPIRITUAL CARE THROUGH WORSHIP SERVICE, BIBLE STUDY GROUPS, AND RESIDENT AND FAMILY SUPPORT.THE SKILLED NURSING FACILITY HAD 375 ADMISSIONS AND 401 DISCHARGES FROM 10/01/12 TO 09/30/13. AN INCREASING AREA OF FOCUS IS OUR SHORT-TERM REHAB CENTER WHERE INDIVIDUALS RECEIVE NECESSARY PHYSICAL, SPEECH, AND OCCUPATIONAL THERAPIES AND RETURN BACK TO THEIR HOME. KNUTE NELSON ACCEPTS ALL PAYOR SOURCES: MEDICARE, MEDICAID, INSURANCE, AND PRIVATE PAY. IF A RESIDENT IS UNABLE TO PAY FOR THEIR SERVICES, WE WILL WORK WITH THEM TO FIND A MEANS TO PAY FOR THEIR SERVICES AND HELP THEM FACILITATE THE APPLICATION PROCESS FOR MEDICAL ASSISTANCE THROUGH FAMILY MEMBERS, KNUTE NELSON AND DOULAS COUNTY SOCIAL SERVICES. THE GOAL OF THE KNUTE NELSON HOME CARE PROGRAM IS TO HELP INDIVIDUALS STAY IN THEIR OWN HOME AS LONG AS POSSIBLE. WE ARE ABLE TO HELP INDIVIDUALS OF ANY AGE WITH SKILLED NURSING SERVICES, PHYSICAL, SPEECH AND OCCUPATIONAL THERAPIES, IV THERAPY, WOUND CARE, PRIVATE DUTY NURSING, HOME HEALTH AIDE, OR ASSESSMENT AND MANAGEMENT OF THEIR MEDICAL NEEDS. WE SERVE INDIVIDUALS WITHIN A 100-MILE RADIUS OF ALEXANDRIA WITH BRANCH OFFICES IN MORRIS, ELBOW LAKE, LONG PRAIRIE, LITTLE FALLS, OLIVIA AND PARK RAPIDS. KNUTE NELSON HOSPICE CARES FOR PEOPLE WITH LIFE-LIMITING ILLNESSES UTILIZING A HOLISTIC APPROACH, INCLUDING MEDICAL, PHYSICAL, EMOTIONAL, SOCIAL AND SPIRITUAL CARE FOR PATIENTS AND FAMILIES. HOSPICE PROVIDES A WIDE RANGE OF SERVICES FROM SKILLED NURSING, MEDICATION AND PAIN MANAGEMENT, HOME HEALTH AIDES, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SOCIAL WORKERS AND CHAPLAIN. HOSPICE IS PROVIDED WHEREVER THE PATIENT CALLS HOME--IN THEIR OWN HOMES, NURSING FACILITIES, OR HOSPITALS. BEREAVEMENT SERVICES AND FOLLOW-UP CARE ARE ALSO A PART OF THE HOSPICE PROGRAM. OUR ASSISTED LIVING FACILITY, NELSON GABLES, PROMOTES INDEPENDENCE, SECURITY AND QUALITY OF LIFE. DAILY COFFEE HOUR, RESTAURANT STYLE MEAL PROGRAM, ACTIVE AGING WELLNESS CLASSES, PARTIES AND OUTINGS KEEP RESIDENTS AS ACTIVE AS THEY WISH TO BE. A 24-HOUR STAFF, UNDER THE DIRECTION OF A REGISTERED NURSE, IS READY TO OFFER ASSISTANCE WITH MEDICATION MANAGEMENT, MEDICATION ADMINISTRATION, BATHING, AND PERSONAL CARE. GRAND ARBOR, REGISTERED THROUGH KNUTE NELSON SENIOR LIVING CAMPUS, LLC, IS AN ENHANCED CONTINUING CARE RETIREMENT COMMUNITY THAT ENCOURAGES ACTIVE LIFESTYLES WITH A TOWN CENTER AND WELLNESS CENTER SET AMONG INDEPENDENT LIVING APARTMENTS; GENERAL AND HIGH ACUITY ASSISTED LIVING APARTMENTS; AND MEMORY CARE ASSISTED LIVING APARTMENTS. A 24-HOUR LICENSED STAFF, UNDER THE DIRECTION OF A REGISTERED NURSE, IS ABLE TO OFFER ASSISTANCE WITH MEDICATION MANAGEMENT, MEDICATION ADMINISTRATION, BATHING, AND OTHER PERSONAL CARE. 19982647 1 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 35 0 1 572 1 1 1 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 MN X MARNIE GUGISBERG SRVPCFO 3207631164 420 12TH AVENUE EAST ALEXANDRIA MN 56308 TOM ANDERSON 1.00 0.00 X X 0 0 0 RUTH NAGLE 1.00 0.00 X X 0 0 0 DOUG HOUSKA 1.00 0.00 X X 0 0 0 DENNIS SCHMIDT 1.00 0.00 X X 0 0 0 JAN LERVICK 1.00 0.00 X 0 0 0 TIM BUSH 1.00 0.00 X 0 0 0 DEREK TROSVIG 1.00 0.00 X 0 0 0 YVONNE KINNEY-HOCKERT 1.00 0.00 X 0 0 0 RICHARD MOEN 1.00 0.00 X 0 0 0 KATHY NOHRE 1.00 0.00 X 0 0 0 MARK ANDERSON 35.00 5.00 X 139055 0 25582 MARNIE GUGISBERG 39.00 1.00 X 84549 0 19427 223604 0 45009 1 0 1 0 INNOVATIVE BUILDERS INC 2715 HIGHWAY 29 SOUTH SUITE 105 ALEXANDRIA MN 56308 GENERAL CONTRACTOR 2446589 MARK LEE EXCAVATING 401 50TH AVE WEST ALEXANDRIA MN 56308 CONTRACTOR 151996 J-BERD MECHANICAL 3308 SOUTHWAY DRIVE ST CLOUD MN 56301 CONTRACTOR 100674 3 103500 35119 138619 RESIDENT SERVICE REVENUE 623000 16367553 16367553 SR APT RENTAL REVENUE 623000 4573479 4573479 OTHER REVENUE 900099 280635 162481 118154 AUXILIARY AND COFFEE SHOP 721000 61494 61494 21283161 88326 88326 21510106 21165007 118154 88326 17054 17054 268727 268727 11147582 10506346 641236 96823 96823 1199908 1130552 69356 882564 814578 67986 24895 24895 19873 19873 1014760 934997 79763 105308 103769 1539 856603 708466 148137 864472 864472 423261 13040 410221 32167 3109 29058 1488282 1488282 1991467 1991467 212145 212145 FOOD 649194 649194 SURCHARGE & PRE SCREEN 375477 375477 MEDICAL SUPPLIES 284754 284754 LICENSES & PERMITS 55013 14868 40145 183510 89168 94342 22193839 19982647 2209653 1539 1870185 1804837 1438464 2295754 1321 1023 135626 155077 48659433 17038455 32505647 31620978 2808332 2206300 3513961 3788453 259167 255000 759221 701298 43291924 42828720 1851022 2230410 27367618 26939274 41370 43299 80128 213583 318649 276012 29658787 29702578 X 13633137 13126142 13633137 13126142 43291924 42828720 X -683733 -97754 274492 X 0 1 X 1 0 X 1393110 3000 5284 138619 1540013 15032966 15508181 15896197 18071000 21165007 85673351 16426076 15511181 15896197 18076284 21303626 87213364 0 0 0 87213364 60584 38773 22061 90821 88326 300565 60584 38773 22061 90821 88326 300565 16486660 15549954 15918258 18167105 21391952 87513929 0.99660 0.99540 0.00340 0.00460 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 2465190 2465190 36541376 11890761 24650615 8253059 4487745 3765314 1399808 659949 739859 31620978 CAREVENTURES COOPERATIVE 5000 F INTEREST IN KNUTE NELSON FOUNDATION 3783453 F 3788453 INSURANCE RESERVE 174567 RESERVATION DEPOSITS 101445 276012 X 21683502 276896 276896 21406606 103500 103500 21510106 22304110 110271 110271 22193839 0 22193839 PART IV, LINE 2B: THE ORGANIZATION ACTS AS A CUSTODIAN FOR THE FUNDS OF THE RESIDENTS OF THE HOME AND ASSISTED LIVING. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE HOME IS ORGANIZED AS A MINNESOTA NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). SENIOR LIVING MAINTAINS EXEMPT STATUS UNDER THE HOME'S EXEMPTION SINCE THE HOME IS THE SOLE MEMBER OF SENIOR LIVING. THE HOME IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE CORPORATION IS SUBJECT TO INCOME TAX ON ANY NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO THEIR EXEMPT PURPOSE. THE CORPORATION FILES AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS TO REPORT ITS UNRELATED BUSINESS TAXABLE INCOME. THE CORPORATION BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND, AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX LIABILITIES IN INCOME TAX EXPENSE, IF SUCH INTEREST AND PENALTIES ARE INCURRED. PART XI, LINE 2D - OTHER ADJUSTMENTS: FOUNDATION REVENUE INCLUDED IN CONSOLIDATED FINANCIAL STATEMENTS 276,896. PART XI, LINE 4B - OTHER ADJUSTMENTS: TRANSFER FROM RELATED PARTY REPORTED IN FUND BALANCE ON FINANCIAL STATEMENTS 103,500. PART XII, LINE 2D - OTHER ADJUSTMENTS: FOUNDATION EXPENSES INCLUDED IN CONSOLIDATED FINANCIAL STATEMENTS 110,271. 1 SCHOLARSHIPS 7 17054 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: KNUTE NELSON MAKES PAYMENTS DIRECTLY TO THE SCHOOL AND DIRECTLY TO THE INDIVIDUALS, DEPENDING ON THE CIRCUMSTANCE. FOR PAYMENTS MADE DIRECTLY TO INDIVIDUALS, A RECEIPT MUST BE PROVIDED SHOWING BOOK OR TUITION EXPENSE BEFORE THE SCHOLARSHIP IS ISSUED. X X X X 0 0 0 0 0 0 0 0 0 MARK ANDERSON 139055 0 0 0 0 0 8400 0 17239 0 164694 0 0 0 A CITY OF ALEXANDRIA MINNESOTA 416004926 015185AL5 2010-07-08 19865000 BUILD SENIOR HOUSING CAMPUS 0 0 0 B CITY OF ALEXANDRIA MINNESOTA 416004926 2006-06-08 4300000 ASSISTED LIVING FACILITY AND REFUND PRIOR BONDS ISSUED 7/17/95 0 0 0 C CITY OF ALEXANDRIA MINNESOTA 416004926 2010-07-08 4500000 SKILLED NURSING FACILITY PROJECT 0 0 0 A 19865000 1670529 298127 570936 13028496 2012 0 0 1 1 B 929170 4300000 113002 83188 3206140 1010742 2007 1 0 1 1 C 796556 4500000 4500000 2010 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 0 1 0 1 0 0 0 0 C 0 0 0 0 1 0 0 0 0 A 0 B 0 C 0 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 KNUTE NELSON HOSPICE WAS STARTED IN JANUARY 2013. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE SHALL INCLUDE THE CHAIR, THE VICE-CHAIR, THE PRESIDENT, THE TREASURER, THE SECRETARY AND SUCH OTHER INDIVIDUALS, IF ANY, AS MAY BE APPOINTED BY THE BOARD FROM TIME TO TIME. THE EXECUTIVE COMMITTEE SHALL HAVE THE AUTHORITY OF THE BOARD IN THE MANAGEMENT OF THE BUSINESS OF THIS CORPORATION IN THE INTERVAL BETWEEN BOARD MEETINGS, AND THE EXECUTIVE COMMITTEE SHALL AT ALL TIMES BE SUBJECT TO THE CONTROL AND DIRECTION OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL HAVE SUCH OTHER DUTIES AS MAY BE PRESCRIBED BY THE BOARD FROM TIME TO TIME. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERSHIP OF THE ORGANIZATION IS MADE UP OF FOURTEEN AREA LUTHERAN CHURCHES WHICH ARE ELECTED AS MEMBERS BY THE BOARD OF DIRECTORS OF THE ORGANIZATION. AT ALL TIMES, THE MAJORITY OF MEMBERS OF THE ORGANIZATION ARE REQUIRED TO BE CONGREGATIONS OF THE EVANGELICAL LUTHERAN CHURCH IN AMERICA, OR ITS SUCCESSOR. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S NOMINATING COMMITTEE, WHICH CONSISTS OF TWO VOTING DELEGATES OF MEMBERS ELECTED BY THE MEMBERS AT THE ANNUAL MEETING OF MEMBERS, THE PRESIDENT OF THE AUXILIARY/FRIENDS OF KNUTE, AND TWO DIRECTORS APPOINTED BY THE BOARD OF DIRECTORS, MAKES RECOMMENDATIONS FOR ELECTIONS TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS IS THEN ELECTED BY ITS MEMBERS AT AN ANNUAL MEETING. FORM 990, PART VI, SECTION A, LINE 7B THE AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION OR BYLAWS NEED TO BE APPROVED BY A MAJORITY OF THE DIRECTORS AND THE VOTING MEMBER DELEGATES. FORM 990, PART VI, SECTION B, LINE 11 THE RETURN IS REVIEWED INITIALLY BY THE CFO AND CEO. THE FINANCE & AUDIT COMMITTEE THEN REVIEWS, PROVIDES A COPY TO THE BOARD OF DIRECTORS, AND MAKES A RECOMMENDATION TO THE BOARD OF DIRECTORS TO APPROVE THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C EACH OFFICER, DIRECTOR, AND KEY EMPLOYEE IS REQUIRED TO FILL OUT A CONFLICT OF INTEREST FORM ANNUALLY. THE FORM IS REVIEWED INITIALLY BY THE PRESIDENT OF THE BOARD OF DIRECTORS AND THE CEO FOR POTENTIAL CONFLICTS. IF A CONFLICT EXISTS, IT IS REVIEWED BY THE BOARD OF DIRECTORS. ANY PERSON WITH A CONFLICT IS RESTRICTED FROM VOTING ON RELATED MATTERS. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD DETERMINES THE COMPENSATION OF THE CEO BASED ON COMPARABILITY DATA. THE CEO IS REVIEWED ANNUALLY BY THE EXECUTIVE BOARD WHICH THEN REPORTS BACK TO THE FULL BOARD OF DIRECTORS. THE DECISION IS NOTED IN THE BOARD MINUTES. THE CEO DETERMINES THE COMPENSATION OF THE CFO BASED ON COMPARABILITY DATA AND PRESENTS THIS INFORMATION TO THE EXECUTIVE TEAM OF THE BOARD OF DIRECTORS. THIS PROCESS TAKES PLACE ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN VALUE OF FOUNDATION 274,492. KNUTE NELSON SENIOR LIVING CAMPUS LLC 420 12TH AVENUE EAST ALEXANDRIA MN 56308 272940787 SENIOR HOUSING MN 4774392 27574488 KNUTE NELSON KNUTE NELSON FOUNDATION 420 12TH AVENUE EAST ALEXANDRIA MN 56308 411451486 FUNDRAISING MN 501(C)(3) LINE 11A, I KNUTE NELSON 1 0 0 1 0 0 0 0 0 1 0 0 1 1 1 1 0 1 0 1 KNUTE NELSON FOUNDATION C 103500 ACTUAL AMOUNT